Chemo for Advanced Prostate Cancer

nodawgs

Since my diagnosis in 2002, I've had all FDA-approved treatments as well as all more popularly used off-label treatments. My clinic had to resort to chemo salvage therapy after I started reflecting a refractory response to Casodex/Lupron toward the end of 2007 when my PSA started abruptly rising.

I recently demonstrated a refractory response after only 7-infusions of Taxotere (docetaxel). My PSA initially dropped to 695.2, then started reflecting a refractory reponse when it rose to 1,075.0.

My luck with mitoxantrone was even worse, demonstrating a refractory response after only 3-infusions with a PSA of 1,200.7.

Having run out of options, I am currently under no treatment other than pain medications. Does anyone know of any other chemotherapy drugs that have been successful in slowing progression?

Also, I'm having difficulty in locating a clinic having in-depth experience in the treatment of metastasized, hormone-refractory prostate cancer. I live in the Dallas-Fort Worth Area.

Best Regards,

nodawgs

Sharon16

Nodawgs, just a couple of
Nodawgs, just a couple of thoughts that entered my mind - have you tried high or low dose ketoconazole? My husband recently began low dose and has seen a PSA drop with no side effects. Have your doctors discussed adding another drug to the Taxotere? I have read it is often more effective in combination with another drug such as Emcyt. Another possibility might be Carboplatin? My husband's med. onc. has recommended Taxotere plus Avastin when he begins chemo. I'm sure others will have more suggestions. Please keep us posted. All my best, Sharon.

nodawgs

Sharon16 said:

Nodawgs, just a couple of
Nodawgs, just a couple of thoughts that entered my mind - have you tried high or low dose ketoconazole? My husband recently began low dose and has seen a PSA drop with no side effects. Have your doctors discussed adding another drug to the Taxotere? I have read it is often more effective in combination with another drug such as Emcyt. Another possibility might be Carboplatin? My husband's med. onc. has recommended Taxotere plus Avastin when he begins chemo. I'm sure others will have more suggestions. Please keep us posted. All my best, Sharon.

Ketoconazole
Thanks, Sharon

Yes, M.D. Anderson put me through a Ketoconazole regimen last year. There was no meausurable response other than an exponential rise in PSA only a month later. The combination possibilities of, say Taxotere (docetaxel) and any other drug are numerous, but I've had the FDA-approved version of Taxotere (docetaxel) and prednisone. Like all others, it also provided only a temporary drop in PSA.

Although physical discomforts strongly indicated a refractory response occurred somewhere between infusion No. 5 and 6, I completed infusion number 7, though at a reduced dosage. For my 7th infusion, they dropped the dosage from 75mg/m2 to the 60mg/m2 adverse event level. My PSA increase took another exponential climb, including a ditto with yet another chemo, mitoxantrone.

Currently I'm seeking a facility to provide exactly what your suggesting...other chemos and chemo combinations shown to work in the past to buy a little time. At the moment, CD copies of my records are being sent to the Baylor Sammons Cancer Center in Dallas. That would work for me because I live in the Dallas suburb of Plano, only 20-30 minutes away.

Again, my many thanks...

"Perry" aka nodawgs

Sharon16

nodawgs said:

Ketoconazole
Thanks, Sharon

Yes, M.D. Anderson put me through a Ketoconazole regimen last year. There was no meausurable response other than an exponential rise in PSA only a month later. The combination possibilities of, say Taxotere (docetaxel) and any other drug are numerous, but I've had the FDA-approved version of Taxotere (docetaxel) and prednisone. Like all others, it also provided only a temporary drop in PSA.

Although physical discomforts strongly indicated a refractory response occurred somewhere between infusion No. 5 and 6, I completed infusion number 7, though at a reduced dosage. For my 7th infusion, they dropped the dosage from 75mg/m2 to the 60mg/m2 adverse event level. My PSA increase took another exponential climb, including a ditto with yet another chemo, mitoxantrone.

Currently I'm seeking a facility to provide exactly what your suggesting...other chemos and chemo combinations shown to work in the past to buy a little time. At the moment, CD copies of my records are being sent to the Baylor Sammons Cancer Center in Dallas. That would work for me because I live in the Dallas suburb of Plano, only 20-30 minutes away.

Again, my many thanks...

"Perry" aka nodawgs

Perry, yes I did see while
Perry, yes I did see while reading through your member page that you had previously tried Ketoconazole. I think you are 100 percent right to pursue other chemo options besides single agent Taxotere. Hopefully you will find an oncologist who will be "creative" - as you are well aware, chemo drugs are often used off label in this and other types of cancer. I know you are a very strong person and like you said, we have to help ourselves to buy more time to spend here on this earth with our friends and family. Best of luck with the Baylor Center - please keep us posted.

Pradeep Raj

Sharon16 said:

Perry, yes I did see while
Perry, yes I did see while reading through your member page that you had previously tried Ketoconazole. I think you are 100 percent right to pursue other chemo options besides single agent Taxotere. Hopefully you will find an oncologist who will be "creative" - as you are well aware, chemo drugs are often used off label in this and other types of cancer. I know you are a very strong person and like you said, we have to help ourselves to buy more time to spend here on this earth with our friends and family. Best of luck with the Baylor Center - please keep us posted.

Chemo for advanced AIPC

Hello, i have just joined and here I am
I am putting this here because i belong here. This is not a comment or a reply. This is a new post about my status. i need the same kind of help.
i have just finished 14 infusions of Docetaxel (Taxotere at 60 mg/m2) my docs thought that dose is best for me. there were hardly any side effects -i lost much of my thick bunch of hair, though. i am not quite bald now. i am now 48.
the point is my PSA has started to climb. the number is not friegtening but the trend is. my PSA was down to 3.84 ng/mL when the drug was stopped last October. Nov 29 PSA touched a low 3.55. Now Dec 27 it showed 4.34. (all from a reputed lab in India -Ranbaxy)
Now i am afraid -what next for me?
with Regards
Pradeep
Hyderabad, India

jimbeam50

After 6 months on Casodex it
After 6 months on Casodex it suddenly stopped working and my husband's PSA went up to 1200, He just started taking Ketoconazole 1200 mg. on December 26th. He was having numbness in his leg and a MRI was done to see if there was a tumor pressing on a nerve. There wasn't. Now the doctor wants to do a spinal tap on 1/8 to see if there is cancer cells in his spinal fluid. If there is she said they will do chemo. Has anyone had this done? We already know the cancer is in his bones. All the doctors thought he was doing so well on the Casodex, his PSA had gone down to 67 the first of October and then he started having the leg numbness before Thanksgiving. I can't believe it changed that fast.

Sheila

nodawgs

What's after Docetaxel and Mitoxantrone...Baylor Hosp, etc.
I'm afraid the bone pain took precedence over everything else. In my opinion, pain from bone metastases is off-the-scale incomparable to any other human pain, presuming consciousness is maintained.

The first two hospitals couldn't come up with anything and was just a tortuous waste of time. Their staff appeared naive about pain management and naive about prostate cancer, period. The last stop should have been my first, the Baylor-Sammons Cancer Center in Dallas. My physician was their director of trials.

After a rushed check-in and scans, I was transferred to their cardiac unit I was later told was to monitor my heart's reaction to one of primary pain relievers they had in mind: methadone. Believe it or not, methadone was originally developed as a pain-reliever...an analgesic, NOT a detox agent. However, methadone is highly reactive to many other drugs and can disrupt the arrythm of the heart. I was told that 24-hours of my stay in the cardiac unit was a study for that purpose...and I passed, though I'm now on a heart medication, I presume as a safeguard. I'll find out more about that with my next appointment.

For days, I survived in the hospital on liquid analgesics: and IV in each arm. In one IV was connected to a morphine pump that made available .5 MG hydromorphone every 8-minutes. A push-button switch fit in my gown pocket. When I pushed the button, the pump made a "beep" as feed-back and .5 MG of hydropmorphone (synthetic morphine derivative) was pushed into the IV. If I pushed the button before 8-minutes was up, it made no "beep" and I presume it didn't provide a shot of morphine, either. Every 8-hours, a nurse manually injected 15 MG of methadone every 8-hours. The every 8-hour injection of methadone was a controlled release analgesic for chronic (all-the-time) pain and the hydromorphone pump was for Instant Release, break-through pain. They used how much I used of each and the frequency of use to determine what my pill-form configuration would be for release from the hospital.

Well, that's where I am now...home trying to gather my wits and above all, keep the bone pain controlled. I still have a small oncology firm willing to file the Compassionate Use Application, but they don't know squat about the filing process. However, they state if I will dig all that up, they'll give it a try.

Other than that...I hate to admit it, but I'm at the end of my rope. Not much else I can say.

shipjim

nodawgs said:

What's after Docetaxel and Mitoxantrone...Baylor Hosp, etc.
I'm afraid the bone pain took precedence over everything else. In my opinion, pain from bone metastases is off-the-scale incomparable to any other human pain, presuming consciousness is maintained.

The first two hospitals couldn't come up with anything and was just a tortuous waste of time. Their staff appeared naive about pain management and naive about prostate cancer, period. The last stop should have been my first, the Baylor-Sammons Cancer Center in Dallas. My physician was their director of trials.

After a rushed check-in and scans, I was transferred to their cardiac unit I was later told was to monitor my heart's reaction to one of primary pain relievers they had in mind: methadone. Believe it or not, methadone was originally developed as a pain-reliever...an analgesic, NOT a detox agent. However, methadone is highly reactive to many other drugs and can disrupt the arrythm of the heart. I was told that 24-hours of my stay in the cardiac unit was a study for that purpose...and I passed, though I'm now on a heart medication, I presume as a safeguard. I'll find out more about that with my next appointment.

For days, I survived in the hospital on liquid analgesics: and IV in each arm. In one IV was connected to a morphine pump that made available .5 MG hydromorphone every 8-minutes. A push-button switch fit in my gown pocket. When I pushed the button, the pump made a "beep" as feed-back and .5 MG of hydropmorphone (synthetic morphine derivative) was pushed into the IV. If I pushed the button before 8-minutes was up, it made no "beep" and I presume it didn't provide a shot of morphine, either. Every 8-hours, a nurse manually injected 15 MG of methadone every 8-hours. The every 8-hour injection of methadone was a controlled release analgesic for chronic (all-the-time) pain and the hydromorphone pump was for Instant Release, break-through pain. They used how much I used of each and the frequency of use to determine what my pill-form configuration would be for release from the hospital.

Well, that's where I am now...home trying to gather my wits and above all, keep the bone pain controlled. I still have a small oncology firm willing to file the Compassionate Use Application, but they don't know squat about the filing process. However, they state if I will dig all that up, they'll give it a try.

Other than that...I hate to admit it, but I'm at the end of my rope. Not much else I can say.

Thanks for the great updates and often funny stories.
I've followed your blogs all the time. I'm lucky with a simple resolution for myself the old robot. Your courage has been tremendous and you've given many of us pause for thought of what could've been hopefully we will use our time to good use and not squander it with self pity.

Hell's bells, we're on the green side of the grass.

Thanks for all you've given us. I hope you can keep posting and that someone will tells us when you can't.

God bless, good luck. jj

But_Wiser

jimbeam50 said:

After 6 months on Casodex it
After 6 months on Casodex it suddenly stopped working and my husband's PSA went up to 1200, He just started taking Ketoconazole 1200 mg. on December 26th. He was having numbness in his leg and a MRI was done to see if there was a tumor pressing on a nerve. There wasn't. Now the doctor wants to do a spinal tap on 1/8 to see if there is cancer cells in his spinal fluid. If there is she said they will do chemo. Has anyone had this done? We already know the cancer is in his bones. All the doctors thought he was doing so well on the Casodex, his PSA had gone down to 67 the first of October and then he started having the leg numbness before Thanksgiving. I can't believe it changed that fast.

Sheila

Hope for Sheila
Dear Sheila,

Hope your husband is out of the turmoil. Did you resort to radio therapy? My father has bone mets too. We are on the verge of getting chemo. Prayers.
Ali

nymets1

shipjim said:

Thanks for the great updates and often funny stories.
I've followed your blogs all the time. I'm lucky with a simple resolution for myself the old robot. Your courage has been tremendous and you've given many of us pause for thought of what could've been hopefully we will use our time to good use and not squander it with self pity.

Hell's bells, we're on the green side of the grass.

Thanks for all you've given us. I hope you can keep posting and that someone will tells us when you can't.

God bless, good luck. jj

Nodawg,
Hang in there,
Nodawg,

Hang in there, brother.

I know you have tried just about everything but just in case:

Did they combine the Taxotere with Emcyt?

Have you ever taken Emcyt?

Have you ever taken low-dose DES (with Coumidin)?

Otherwise, I know you are trying your best to get into a trial; how bout seeing if you can get Provenge through "Compassionate Use" For God'sakes, its going to be approved in a month ot two anyway but you need it now.

One lsat thing:

See if you can get an asap phone meeting with Dr Snuffy Myers. He ain't God but he's got a lot
of knowledge and good advice.

Myers Website:
http://www.prostateforum.com/contact.html

I hope to see you here a year from now!

Joey G